What to Expect When Starting Therapy
Hi there!
Welcome back to the MoodiNews. Every Thursday, we discuss a variety of matters related to mental health and self-improvement.
I’m so glad you’re here.
In today’s post, we are going to discuss: WHAT TO EXPECT WHEN STARTING THERAPY!
If you’ve never been to therapy before but have decided recently to go, then you’ve come to the right place! In order to help you anticipate what’s coming, I (a therapist) have compiled a rough outline of what your first few session(s) might look like.
When it comes to traditional (outpatient) therapy, here’s what you can likely expect:
1) Your therapist is going to ask you to fill out some paperwork before the appointment starts. If they send you this information beforehand, MAKE SURE TO HAVE IT DONE BEFORE THE DAY OF YOUR APPOINTMENT. Your therapist will need you to complete/sign several documents before they can start working with you, and if you forget your paperwork or do not complete it proactively, you run the risk of canceling your appointment. (More on this below.)
2) Your therapist will probably want to complete an intake assessment with you the first time that you come in. An intake (diagnostic) assessment is basically a long list of questions that your therapist will ask you about your current concerns (i.e., “I can’t get out of bed; I’m constantly fighting with my kids; I’m totally burned out at work…”). They will also want to know about your background (i.e., early childhood experiences, your education level, any significant relationships, any previous trauma, relevant work and health history, etc.), as well as your overall goals for therapy (i.e., “I want to feel less anxious and stop fighting with my spouse…”). There’s no need to prepare for these questions beforehand—therapy is not like a job interview! If you’re worried about what’s going to be expected of you, just show up and participate as best you can, and you will be totally fine.
3) During the first meeting, let your therapist lead the conversation. One of the most common fears people have is not knowing what to talk about—so, if that’s you, don’t worry about it. Your therapist is very comfortable with the intake process, and they will guide you through the process until you feel comfortable with how everything works.
4) Some therapists will choose to structure their first session in a casual, conversational way. Others will do choose to do their initial assessment in a more formalized (Q & A) way. Both are fine—just know that their intention is not to interrogate you, only to understand what you are looking for so that they can help you.
5) Typically, intake assessments last between 60-90 minutes. Some therapists will want to complete your intake appointment all in one sitting (which might go longer than 60 minutes). Others will elect to break up your first ‘getting to know you’ conversation into two separate sessions, if necessary.
6) Treatment planning (i.e., discussing your goals for therapy) will likely be a part of your first appointment as well. If you don’t know what your goals are quite yet, that’s okay—again, your therapist will help guide that discussion. Also, if your goals aren’t discussed in your first appointment, then that will likely be the focus of your second session. (Similar to the assessment approaches mentioned above, some therapists choose to do their treatment planning in a formal manner, and they will write up a list of goals that you’ll be working on while you’re in the room. Other therapists will be more casual in their approach, and will have you verbally identify what you would like to work on during your time in treatment, but won’t make it explicit that they are making a treatment plan.)
7) During your first (or all) of your session(s), your therapist might take notes—this is common. As time goes on, it may no longer be necessary, but at least in the beginning, taking notes is considered standard procedure on your therapist’s part. (Some therapists will document what you say with pen and paper, and others will type their notes on a laptop or computer. If you have concerns about a paper trail following certain information that you discuss with them, let them know.)
8) Once your assessment and treatment planning are completed, the road is clear for you and your therapist to take your treatment in any direction that you wish. As time goes on, some therapists will assign you homework, and most, at the very least, will teach you skills to try outside of session. After a few months of therapy, your therapist will likely want to review your treatment plan with you, in order to make sure that your goals haven’t changed and that your work together is proving useful. This is considered best practice, and it shows that your therapist is invested in your progress.
9) Keep in mind that building a trusting relationship with your therapist is the key to long-term success, so don’t be afraid to be yourself and ask for what you really want/need, right from the start. The right therapist for you is going to appreciate your goals and respect you as an individual. Feel free to express yourself, crack jokes, and get comfortable discussing what you really think and feel—it’s okay to enjoy yourself in the process!
In order to help you feel as comfortable as possible the first time that you go in for therapy, I’ve included a few additional points below that might help make the process a bit less formidable:
1) If you’re nervous about your first appointment, just know that that’s totally normal. Most people report feeling anxious when they first come in for an appointment, even if they’ve been to therapy before…
2) Remember last week, when we discussed asking for a preliminary consultation with your therapist? Don’t forget that this might still be an option for you, and it can certainly help to break the ice if you can connect with your therapist briefly before your first appointment. (It also provides a great opportunity for you to ask questions about what you can expect during your first appointment(s), which will likely help your nerves go down…)
3) In order to prevent any unnecessary issues, be sure to arrive early to your first appointment. Especially if you are someone who tends to run late, make sure that you schedule enough time to arrive BEFORE (not when!) your appointment is scheduled to start. (If you are going to be meeting with your therapist virtually, be sure to sign on in advance so that you don’t run into any technical difficulties.) Arriving with some extra time to spare will not only give you time to relax before your appointment (rather than rolling in with your hair on fire!), but it will also prevent things from getting rescheduled should you arrive too late by mistake.
4) MAKE SURE YOU PLAN AHEAD FOR PAPERWORK TIME. Before your first appointment can begin, you (or your legal guardian) will need to complete intake forms consenting to the policies of psychotherapeutic treatment. There’s no need to be intimidated by these forms, but do know that your therapist won’t be able to work with you until they are completed, so you will need to prioritize completing them, per your therapist’s instructions, before your work together can commence. (If your therapist sends you electronic documents to fill out ahead of time online, I recommend completing them well in advance—ideally 48 hours or more before your first appointment. Other therapists will send you their forms in the mail, and, in that case, you will need to remember to fill them out and bring them with you to your first appointment. Lastly, if you will be completing your intake paperwork onsite the day of your first appointment, give yourself plenty of time to complete those forms—and, if your therapist asks you to arrive 30 minutes early, it’s for a good reason, so be sure to follow their instructions.)
5) If applicable, be sure to arrive to your first appointment with a copy of your insurance information, as well as your preferred method of payment, on hand. Most therapists will choose to delay your treatment if you are unable to provide these items upfront, because it can turn into a logistical nightmare for providers to begin treatment before this information has been received.
6) If you’re worried about appearing ‘put together’ so that your therapist won’t judge you the first time that you meet—don’t worry about it. If spending time on your physical presentation helps you feel confident going in, then knock yourself out! But just know that what really matters is that you get yourself to your appointment, in whatever capacity you can. (Your therapist will be happy to see you, either way—trust me. Even if you’re struggling on the day of your first appointment, it’s still important that you go. Your therapist has seen it all—and they will be more impressed that you pushed through some anxiety or apathy to get to your first appointment than they will be if you show up pretending to have everything under control.)
7) It always helps to be well-fed, well-hydrated, and well-rested for your first (and all your future) therapy appointments. If you lose some sleep the night before your first appointment because you’re nervous—that’s not a dealbreaker. However, a hungry or tired mind inevitably becomes a distracted mind, so, long-term, do your best to be prepared for your therapy appointments by meeting your physical needs beforehand.
8) You can always choose not to answer a question that your therapist asks you—at any time, not just during your initial appointment. That being said, when you meet with your therapist, be as honest as possible. Lots of people omit information about their lives until they know that they can trust their therapist—and this makes sense—but I would not recommend getting into the habit of lying to your therapist. It’s better to tell them you’re not ready to talk about something than it is to give them information that is either misleading or untrue. (Remember: Therapists hear about the most intimate details of people’s lives all day long, and, consequently, it takes A LOT to surprise or offend us. Whatever you’re struggling with, you and your therapist can work through it together—that’s why you’re there. And, if you’re worried about saying something that might get you into trouble, I recommend talking with your therapist about that. Therapists are mandated to report certain issues, but we are not criminal investigators. It’s not our job to tell on you—it’s only our job to keep people safe.)
9) If you are still wondering what you can expect out of your first trip to therapy, ask others who have tried it about their personal experience. Hearing what therapy has been like for other people might help validate your initial concerns while you’re getting started. (Just know that the first session can become immemorable after a while—for instance, I can’t even remember mine. Furthermore, if people are talking about therapy more casually than you’re able to right now, that’s only because they’re used to it, and you, too, will get more comfortable with the process over time.)
As always, I hope that you find this information helpful.
I respect you for taking the terrifying (yet courageous) step to start therapy! As with anything worth pursuing:
“It doesn’t have to be perfect, it just has to start.” -Angelia Trinidad